Basic Information
| Provider Information | |||||||||
| NPI: | 1427495274 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAYEEMUDDIN | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16259 SYLVESTER RD SW STE 404 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062411818 | ||||||||
| FaxNumber: | 2535396025 | ||||||||
| Practice Location | |||||||||
| Address1: | 16259 SYLVESTER RD SW STE 404 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062411818 | ||||||||
| FaxNumber: | 2535396025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | M60941810 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | MD60941810 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 2141075 | 05 | WA | MEDICAID |